You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery IV1 Apr 20101220 GRAFTS ARE UNNECESSARY FOR PROXIMAL BULBAR RECONSTRUCTION Ryan Terlecki, Matthew Steele, Celeste Valadez, and Allen Morey Ryan TerleckiRyan Terlecki More articles by this author , Matthew SteeleMatthew Steele More articles by this author , Celeste ValadezCeleste Valadez More articles by this author , and Allen MoreyAllen Morey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.743AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Strictures of the proximal bulbar urethra have been proposed as being uniquely amenable to excision and primary anastomosis (EPA) procedures as opposed to those occurring more distally (J Urol 2007; 177, p37A). We compared our recent experience with reconstruction of proximal versus distal bulbar strictures to assess the relative role of EPA and graft procedures in each area. METHODS We reviewed our database of all urethroplasties performed by a single surgeon at our referral center during a two year period. Data analyzed included patient history and demographics, operative details, stricture length and location, and clinical outcomes. The proximal bulbar urethra was defined as the segment within 5 cm of the membranous urethra; the distal bulb was defined as the adjoining segment extending to the penoscrotal junction. Cases involving the pendulous or posterior urethra were excluded. RESULTS Of the 210 consecutive men having urethral reconstruction at our center from 2007-2009, 112 had bulbar strictures. Proximal bulbar urethral strictures comprised the majority of cases (72/112, 64%) and all 72 were treated via EPA procedures: no patient with a proximal bulbar stricture required a graft procedure. Median stricture length was 2 cm (range 1-4.5 cm) although 31/72 (43%) were of intermediate length (2.5-5 cm); median stretched penile length (SPL) was 15 cm. Prior to referral, treatment had been performed in 51/72 (71%) of patients, with 10/72 (14%) having prior urethroplasty. At a median follow-up of 358 days, recurrence was seen in only 1/72 (1.4%), a patient with a history of multiple prior urethral dilation procedures. Distal bulbar strictures comprised 40/112 (36%) of cases and were treated predominantly with substitution urethroplasty (36/40, 90%), and less commonly via EPA (4/40, 10%). Median stricture length was 2.5 cm and intermediate length strictures were noted in 18/40 (45%). Prior treatment was noted in 26/40 (65%), with 11/40 (28%) having prior urethroplasty. At a median follow-up of 529 days, recurrence was seen in 11/40 (28%). Among intermediate length strictures, recurrence was seen in only 1/30 (3.3%) of those treated with EPA and in 6/19 (32%) managed by graft procedures (p = 0.02). CONCLUSIONS EPA is associated with superior outcomes compared to graft procedures and should be performed whenever possible. Location is of critical importance in selecting the appropriate reconstructive technique for bulbar urethral strictures and the proximal bulb is uniquely amenable to EPA repairs. Our data strongly suggest that grafts are unnecessary for reconstruction of proximal bulbar strictures < 5 cm. Dallas, TX© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e472-e473 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ryan Terlecki More articles by this author Matthew Steele More articles by this author Celeste Valadez More articles by this author Allen Morey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
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